DOCtalk by Dr. Gregg 5/4/12

Crash and (Just a Little) Burn

Earlier this week was pretty darn technically frustrating for me. I had a combo-fiasco happen where multiple servers and “uninterruptible” power supplies failed when we took three power hits within minutes of each other (on a nice, sunny day, no less!) This led to our locally-hosted system going down for a day and requiring full database restoration and the rebuild of half a day’s patient data from notes, memory, e-prescriptions, etc.

Then, as I was writing a blog to describe the problem and talk about how we dealt with it, I had the strangest issue with Word. It saved the post – which had the above title – but the post itself was an old one. In other words, the title saved correctly, but not the body of the story. (I’m still scratching my head on that one.)

But you’ll note that though I’ve kept that original title, I have veered far afield from my original content. Recent news about my EHR vendor – well, they’re still sort of my EHR vendor – has usurped both this post’s title and content. You’ll see why I felt the title was worth repurposing if you continue to read just a bit further. (And, if Mr. H consents to posting this — which he may not – since the news I’m about to add will be “unsubstantiated”.)

Many of you know that there really isn’t much love loss between Allscripts and me. When I broke the news that they were about to announce the sunsetting of my chosen EHR, Peak Practice, on October 5, 2010 (I remember because it was my birthday), their powers-that-were weren’t happy with me. I haven’t been much of a fan of what I’ve seen from them since and haven’t been terribly shy about saying so.

Along comes the news about the failed power coup, subsequent loss of old Eclipsys folks from dismissal or resignation, and the serious stock price tankingness. Yes, there was a little “I knew it would happen” smirk on my face for just a moment, but it didn’t last, as I also have friends and colleagues who either work there or who use their software. I know that this isn’t good news for them, so my personal “Yo, it’s karma, dudes” moment didn’t last.

But, here’s the kicker. I have it from an exquisitely good resource – no, it’s not an Allscripts employee – that they are about to “go legacy” with their Enterprise product.

My source also sent along his/her thoughts on the meltdown, which I’m going to share verbatim here:

Eight years of bad decisions are coming home to roost:

1. Repeated acquisitions at premium price for technologies and systems that do not integrate.

2. Senior management constructed of deal makers, attorneys, and marketers. Barely a single product or clinical person among them.

3. Inability to retain key technical and clinical personnel due to (2) above.

4. No coherent strategy other than to acquire and grow revenue through acquisition of disparate businesses.

The effects of these four interrelated factors ripple throughout Allscripts and its customers. Tullman is the driving force behind this. It will not change as long as he remains in charge.

I really have nothing to gain by putting this out, and even the momentary sense of “See, if you hadn’t sunsetted my dear old Peak Practice, none of this would have happened” is completely overridden by my sorrow for the end users of Allscripts products who are the real losers (well, them and all those now significantly less well-invested shareholders.) I’m not sure if there are any real winners here.

Maybe I should have retitled this “Crash and (A Whole Lotta) Burn”.

From the trenches…

“As a single withered tree, if set aflame, causes a whole forest to burn, so does a rascal son destroy a whole family.” – Chanakya

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 5/3/12

Olmsted Medical Center (MN) extends its partnership with MED3OOO through 2017.

Practice Fusion launches an API that allows any laboratory to connect directly to its EMR and send lab results using standard HL7 data files.

From Wednesday’s HIT Policy Committee meeting:

• The Medicare and Medicaid MU programs have paid EPs an estimated $1,671,000 through the end of April.
• RECs have now enrolled more than 40% (132,000) of all primary care providers in the country; 50,000 of those are in practices with fewer than 10 physicians.
• Drug formulary, immunization registries, and patient list are the most popular menu objectives for EPs.
• Of the 62,807 EPs that have attested, 258 were unsuccessful initially. All but 99 of those have successfully resubmitted.

Navicure announces it has added 344 new practice locations to its client base during the first quarter of 2012, a 112% increase over Q1 2011 bookings. The company also reports its first quarter revenues were up 24% from a year ago.

Federal officials charge 108 doctors, nurses, and other healthcare providers with almost half a billion dollars in fraudulent Medicare billing during a “nationwide takedown” on Wednesday. HHS suspended or took other administrative actions against an additional 52 providers for “credible allegations of fraud.” Officials have so far arrested at least 87 individuals.

athenahealth earns a spot on Boston Business Journal’s 2012 list of Best Places to Work.

Sermo partners with TheVisualMD, a producer of visual health content, to offer video and other media tools.

West Tennessee Bone selects SRS EHR for its 11 providers.

Anthem Blue Cross (CA) rolls out the Availity information network at no charge to physicians, giving them access to patients’ eligibility and benefits and the ability to submit and monitor claims online.  Physicians will also have access to CareProfile, Availity’s claims-based EMR, which provides 24 months of a patient’s most recent medical history.

A JAMA-published study suggests that text messaging, electronic reminder devices, and pagers might improve medication adherence in the short term, but the long term effectiveness remains unclear.

E-mail Inga.

News 5/1/12

General Accountability Office (GAO) examines CMS’s EHR incentive program and offers recommendations to improve processes to verify providers have met program requirements:

• Establish time frames for evaluating the effectiveness of CMS’s audit strategy for the Medicare EHR program.
• Evaluate the extent to which CMS should conduct more verifications before making payments for the Medicare program.
• Collect at least as much information from Medicare providers who are participating in the program as it does from Medicaid providers during attestation.
• Offer states the option of having CMS collect Meaningful Use attestations from Medicaid providers on their behalf.

HHS agreed with the first three recommendations, but disagreed with the fourth.

The board of directors of Allscripts elects Dennis Chookaszian its new chair. The former CEO and chairman of CNA Financial Corporation joined the board in September 2010. The board also authorized the repurchase of $200 million in Allscripts common stock. After dropping 36% Friday, Allscripts stock inched up almost 8% Monday, closing at $11.10.

Mr. H, along with readers, have provided a great deal of commentary on the recent Allscripts turmoil. If you are an Allscripts ambulatory client, I’d love to hear your perspective (and will keep your impressions anonymous, of course.)

Orthopaedic & Spine Center (VA) expands its use of White Plume solutions with the addition of the AccelaMOBILE mobile charge capture app.

MedAptus selects Intelligent Medical Objects’ Problem IT technology to integrate into its Professional Charge Capture solution. The combined solution will provide clinicians with rapid diagnosis search when completing charge documentation using the ICD-10 code set.

Boston Business Journal names eClinicalWorks to its Pacesetters Powerhouse Elite in recognition of its 148% growth over four years.

The Greater Miami Chamber of Commerce names CareCloud CEO Albert Santalo winner of its 2012 Technology Entrepreneur of the Year award.

E-mail Inga.

DOCtalk by Dr. Gregg 4/27/12

Odd and Ends

There’s an odd thing I noticed recently while in Chicago for dual meetings of the exec/advisory boards of the Council on Clinical Information Technology (COCIT) and Child Health Informatics Center (CHIC) at the American Academy of Pediatrics (AAP). In each, the conversations have taken a noticeable — and I think encouraging — turn.

As most of you are aware, HIT conversations over the past couple of years have revolved around Meaningful Use, Meaningful Use, Meaningful Use, and more Meaningful Use. On the vendors’ side, conversations – and entire developmental timetables – have been almost exclusively redirected to meeting and matching MU criteria. For users, though they’re still looking for functionality, MU standards and MU hoops through which to jump have also substantially overtaken most all IT-related tête-à-têtes.

So, too, have recent COCIT and CHIC chats been mostly MU-oriented. However, over the past couple of sunny days here in the City of the Big Shoulders, I’ve noticed a rather encouraging change. Amongst people who are exclusively focused upon HIT as relates to pediatrics, MU has sort of moved into the backseat, and in a very good way.

A few highlights of conversational topics may help to illustrate this point:

• During one meeting, we had a presentation from a member who had gone to Japan to assess emergency responses to the recent horrific earthquake / tsunami / nuclear meltdown disaster trifecta. Japan’s amazing response to this terrible tragedy, including the impact of information management in such an event, was compared to the dismal and disappointing responses to the recent hurricane and flooding of New Orleans. How HIT impacts, or how HIT is impacted by, such enormous catastrophes can be very challenging considerations.
• Another member was intimately involved with emergency services to the recent earthquake in Haiti. He described the heart-wrenching story of a student trapped for a week who survived by drinking the dripping blood from her fellow students whose dead bodies lay above her in the wreckage. Heartbreakingly, or perhaps mercifully, she later to died due to complications from her nightmare. (Though I doubt HIT may have helped this poor girl, the Haitian disaster has tremendous lessons to teach about dealing with less-developed countries who suffer such calamities.)
• A third physician spoke of the political suicide he experienced by standing up to his institution’s decision to implement a system which he felt was inappropriate for their needs. He described being taken out into the hall by their CMIO and scolded for not getting on the implementation bus. Not one who is known for sharing such inner personal emotions often, his description of the institutional loneliness he has experienced over the past two years as he held to his opinion for the inappropriateness of this system was moving. (He did note a slight indication of vindication recently — others are starting to understand his concerns as the implementation process has proceeded.)
• In reevaluating the priorities for both groups’ efforts, instead of just talking about how we help AAP members to adopt/implement HIT and meet Meaningful Use criteria, we were instead discussing ways to provide AAP expert content via web services to both members and vendors, how to identify and help members use their digital talents to assist their colleagues, and how to expand upon the wonderful, expanded support we’ve been receiving from the upper AAP echelon to promote all things Peds HIT.

In other words, we were talking about providing value: value to the children and families we serve; value to our colleagues; value to HIT vendors looking to resource our expertise, and; value to ourselves. Barely a mention of MU during days of non-stop meetings and post-meeting dinner chats. Refreshing, I must say, though that’s not at all to say that I (or we) are against MU. It’s just nice to get back to discussing and working on all those things toward which MU is designed to help us move.

As to the “Ends” part of this post’s title, this weekend marked the end of service for some very wonderful people. After serving between six and nine years, Drs. Jeannie Marcus, George Kim, Michael Leu, and Alan Zuckerman have come to the end of their COCIT Executive Committee term limits. Though some fresh blood is always good, the leadership and value each of them provided is undeniable. (Knowing them, I’m betting their contributions will continue well past their “title” time.) Thanks, guys.

There’s another of the “Ends” I will especially miss. After eight years, Jennifer Mansour will be leaving the AAP and, from a completely “how does this impact me” mindset, will no longer be my cohort in crime with the Pediatric Office of the Future (POF) exhibit. Jen has done so much more than that in her role as Health Information Technology Initiatives Manager, but her deep understanding of the world of pediatric HIT, rock-solid reliability, wonderful attention to detail, abilities for handling difficult doctors (cough, cough), and her political adeptness were perhaps some of the most important factors leading to the over 500% growth of the POF exhibit.

It has not yet been officially announced anywhere, but the POF will be quite operationally different this October in New Orleans. It’ll have a new name, fantastic new features and values for our attendees, marketing and PR light years beyond anything we’ve ever done, and will be far more accessible to any and all exhibitors (no longer “sponsors”). There will be much more bang per buck for both attendees and vendors. Again, much of this continued evolution has Jen at its core. Thanks for everything, Jen.

The folks filling her shoes seem pretty wonderful, too, I must admit. I just hope they have big enough feet!

From the trenches…

“You know an odd feeling? Sitting on the toilet eating a candy bar.” – George Carlin

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 4/26/12

Quality Systems, the parent company of NextGen, acquires Matrix Management Solutions, a NextGen reseller that provides RCM, implementation, and support services. Quality Systems says the acquisition will “enable NextGen Practice Solutions to expand its footprint among private and hospital-based physicians and groups by leveraging Matrix’s RCM expertise.”

Emdeon completes the re-pricing of its existing senior secured credit facilities and borrows $80 million of additional term loans for general corporate purposes, including potential acquisitions.

Phreesia adds an electronic version of the M-CHAT autism screening tool for toddlers to its patient check-in system.

Cokingtin Eye Center (KS) goes live on MedInformatix’s EMR on May 1.

eClinicalWorks opens a Chicago office to provide a central US presence.

Hawaii Island Beacon Community implements a physician practice redesign program to transform up to 30 independent primary care physician practices into PCMHs. Participating practices will receive at no charge practice assessments, educational tools, and PCMH recognition upon program completion.

The Houston Chronicle reports that that Medicare has overpaid physicians millions of dollars in bonuses, including $33 million in 2010 alone. The overpaid physicians practiced in areas that were once considered underserved but which have since been reclassified. The federal Health Resources and Services Administration is responsible for updating the records of qualified communities, but failed to adjust its lists from 2003 until November 2011. As a result, physicians in at least 311 communities have been incorrectly paid bonuses equal to 10% of each Medicare claim filed. Good luck getting those funds back.

Even though as many as 91% of US physicians were eligible to participate in the Meaningful Use program last year based on Medicare revenue or Medicaid volume, only 11% of EPs had both an EHR with at least 10 of the 15 capabilities required for Stage 1 and had plans to apply for incentives. That’s a far lower participation rate that CMS originally estimated (as high as 36% for the Medicare MU program and 47% for Medicaid’s.)

Overall physician compensation fell in from 2010 to 2011, though the  average pay in several specialties averaged more than $300,000. Radiologists had the highest average compensation ($315,000) and pediatricians the lowest ($158,000.)

Occasional HIStalk Practice contributor Lyle Berkowitz, MD is profiled here discussing Healthfinch, an HIT start-up company he co-founded. Healthfinch’s productivity apps include RefillWizard, which connects to a practice’s EMR and runs prescription refill requests through a Web service.

E-mail Inga.